Free DOMESTIC - Maine

Filing Fee $15.00

NONPROFIT CORPORATION STATE OF MAINE COMMERCIAL REGISTERED AGENT

STATEMENT OF APPOINTMENT or CHANGE

_____________________ Deputy Secretary of State

A True Copy When Attested By Signature

______________________________________
(Name of Corporation as it appears on the records of the Secretary of State)

_____________________ Deputy Secretary of State

Pursuant to 5 MRSA §§105 & 108 the undersigned nonprofit corporation executes and delivers the following statement of appointment or change of a commercial registered agent. FIRST: The name and address of the current registered agent appearing on the record in the Secretary of State's office: _______________________________________________________________________________________ (name of current registered agent) _______________________________________________________________________________________ (physical street address, city, state and zip code) SECOND: The new CRA Public number is: __________________________ The name of the new CRA is: _______________________________________________________ THIRD: Pursuant to 5 MRSA §108.3, the registered agent listed above has consented to serve as the registered agent for this corporation. (To be completed by foreign nonprofit corporations) Jurisdiction of incorporation: ________________________________________________________________ __________________________________________

FOURTH:

Date authorized to carry on activities in the State of Maine:

Dated _________________________

*By

_______________________________________________ (signature) _______________________________________________ (type or print name and capacity)

*This statement MUST be signed by any duly authorized officer. (13-B MRSA §104.1) Please remit your payment made payable to the Maine Secretary of State. Submit completed form to: Secretary of State Division of Corporations, UCC and Commissions 101 State House Station, Augusta, ME 04333-0101 Telephone Inquiries: (207) 624-7752 Email Inquiries: [email protected]

Form No. MNPCA-3-CRA 7/1/2008

Filer Contact Cover Letter

To:

Department of the Secretary of State Division of Corporations, UCC and Commissions 101 State House Station Augusta, ME 04333-0101

Tel. (207) 624-7752

Name of Entity (s): _______________________________________________________________________ _______________________________________________________________________ List type of filing(s) enclosed (i.e. Articles of Incorporation, Articles of Merger, Articles of Amendment, Certificate
of Correction, etc.) Attach additional pages as needed.

________________________________________________________________________ ________________________________________________________________________ Special handling request(s): (check all that apply) Hold for pick up Expedited filing - 24 hour service ($50 additional filing fee per entity, per service) Expedited filing - Immediate service ($100 additional filing fee per entity, per service) Total filing fee(s) enclosed: $ ________________ Contact Information ­ questions regarding the above filing(s), please call or email: (failure to provide a contact name and telephone number or email address will result in the return of the erroneous filing (s) by the Secretary of State's office) ___________________________________
(Name of contact person)

___________________________________
(Daytime telephone number)

____________________________________________________
(Email address)

The enclosed filing(s) and fee(s) are submitted for filing. Please return the attested copy to the following address:

______________________________________________________________________________
(Name of attested recipient)

_____________________________________________________________________________________________
(Firm or Company)

_____________________________________________________________________________________________
(Mailing Address)

_____________________________________________________________________________________________
(City, State & Zip)